Using the Internet to provide cognitive behaviour therapy
A new treatment form has emerged that merges cognitive behaviour therapy with the Internet. By delivering treatment components, mainly in the form of texts presented via web pages, and provide ongoing support using e-mail promising outcomes can be achieved. The literature on this novel form of treatment has grown rapidly over recent years with several controlled trials in the field of anxiety disorders, mood disorders and behavioural medicine. For some of the conditions for which Internet-delivered CBT has been tested, independent replications have shown large effect sizes, for example in the treatment of social anxiety disorder. In some studies, Internet-delivered treatment can achieve similar outcomes as in face-to-face CBT, but the literature thus far is restricted mainly to efficacy trials. This article provides a brief summary of the evidence, comments on the role of the therapist and for which patient and therapist this is suitable. Areas of future research and exploration are identified.
Author's personal copy
Using the Internet to provide cognitive behaviour therapy
Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linko
ping University, Linko
Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
Received 30 November 2008
Received in revised form
5 January 2009
Accepted 20 January 2009
Guided Internet-delivered treatment
A new treatment form has emerged that merges cognitive behaviour therapy with the Internet. By
delivering treatment components, mainly in the form of texts presented via web pages, and provide
ongoing support using e-mail promising outcomes can be achieved. The literature on this novel form of
treatment has grown rapidly over recent years with several controlled trials in the ﬁeld of anxiety
disorders, mood disorders and behavioural medi cine. For some of the conditions for which Internet-
delivered CBT has been tested, independent replications have shown large effect sizes, for example in the
treatment of social anxiety disorder. In some studies, Internet-delivered treatment can achieve similar
outcomes as in face-to-face CBT, but the literature thus far is restricted mainly to efﬁcacy trials. This
article provides a brief summary of the evidence, comments on the role of the therapist and for which
patient and therapist this is suitable. Areas of future research and exploration are identiﬁed.
Ó 2009 Elsevier Ltd. All rights reserved.
Deﬁning Internet-delivered interventions can be problematic as
there are different conceptualisations and viewpoints. A ﬁrst
distinction relates to the Internet itself, as it can be a way to
communicate with a physical person on the other side of the
connection (e.g., e-mail), a way to present information in a more or
less one way direction (information web pages), or a platform for
more interactive programs which do not require any input from
a clinician. Finally, Internet interventions can be a little bit of all
this. In some ways this resembles the problems when trying to
deﬁne psychotherapy, even within cognitive behaviour therapy
(CBT), as we are dealing with different techniques and delivery
approaches. All of these may have an impact on the manner in
which the therapy works. For example, the differences between
individual and group CBT can be substantial, and different change
processes could be involved (Morrison, 2001). In our research
program in Sweden we have developed an approach to Internet-
delivered CBT which is distinct in the sense that it involves
therapist contact, albeit minimised, and that it is not heavily
computerised in terms of interactive programmes requiring no
therapist input. According to Marks, Cavanagh, and Gega (20 07),
computerised interventions should delegate at least some therapy
decisions to the computer, but in the approach I will present in this
paper this is not necessarily the case as the Internet very well can
be used without any automatic, computer generated decision
making. When describing our approach Marks et al. referred to the
Swedish model as ‘‘Net-bibliosystem CBT’’, but that does not fully
catch the essence of the approach. In a paper by our group we
instead proposed the following deﬁnition of guided Internet-
. a therapy that is based on self-help books, guided by an
identiﬁed therapist which gives feedback and answers to
questions, with a scheduling that mirrors face-to-face treat-
ment, and which also can include interactive online features
such as queries to obtain passwords in order to get access to
treatment modules (Andersson, Bergstro
m et al., 2008 p. 164)
As seen from this deﬁnition we used the term self-help, which
may cause some confusion. In research it is often the case that self-
help refers to treatments that are delivered with minimal input
from a clinician (Watkins & Clum, 2008). That approach is different
from purely self-administered self-help. Guided Internet-delivered
treatment is an approach which combines the advantages of
structured self-help materials, presented in an accessible fashion
via the Internet, with the important role played by an identiﬁed
therapist who provide support, encouragement and occasionally
direct therapeutic activities via e-mail (Postel, de Haan, & De Jong,
20 08). As will be seen in this review there are strong reasons to
assume that it is premature to leave out the therapist when moving
to the new format of Internet-delivered CBT. For example, if
Internet delivery is regarded as mainly one way to decrease ther-
apist time, this follows a long-standing tradition in CBT when
Department of Behavioural Sciences and Learning, Linko
ping University, SE-581
ping, Sweden. Tel.: þ46 13 285 840; fax: þ46 13 282 145.
E-mail address: Gerhard.Andersson@liu.se
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Behaviour Research and Therapy 47 (2009) 175–180
Author's personal copy
treatments are shortened without compromising the efﬁcacy
(e.g., Clark et al., 1999; O
The present review will describe and comment on how CBT has
the potential to reach more people by using the Internet. The focus
will not be to describe all studies that have now been conducted
(see Barak, Hen, Boniel-Nissim, & Shapira, 2008), but rather to give
examples of trials and consider questions regarding therapist
factors and dissemination issues. Indeed, systematic reviews of the
literature on Internet-delivered CBT show that moderate to strong
effects are observed at posttreatment (e.g., Cuijpers, van Straten, &
Andersson, 2008a; Spek, Cuijpers et al., 20 07).
Among the ﬁrst conditions to be systematically studied in self-
help research and later on in research on Internet-delivered CBT are
the anxiety disorders. Many people never seek help or do it after
years of suffering (Clark, 1999).
More or less simultaneously, two independent research groups
began to investigate if CBT for panic disorder could be delivered via
the Internet. Typically, treatment consists of text materials like in
bibliotherapy, but presented via the Internet and with some
interactive features. Treatment is supported by a therapist with e-
mail or telephone and duration of treatment is often up to
10 weeks. A few smaller trials by the Australian research group
showed promising outcomes (Klein & Richards, 2001; Richards &
Alvarenga, 2002). Later research by the same group, but with larger
samples and improved programs conﬁrmed the early ﬁndings
(Klein, Richards & Austin, 2006; Richards, Klein, & Austin, 2006),
and also extended the application by including other providers of
treatment (Shandley et al., 2008). In a recent trial they compared
Internet-delivered and face-to-face treatment and found equiva-
lent outcomes (Kiropoulos et al., 2008). In this latter study,
participants with a primary diagnosis of panic disorder were
randomly assigned to either guided Internet-delivered CBT or to
best practice face-to-face CBT. In other words this was an equiva-
lence trial (Piaggio, Elbourne, Altman, Pocock, & Evans, 2006), as
the authors expected and powered their study assuming equal
outcome. The authors found that 30.4% (14/46) of their panic online
treatment participants reached the criteria of high end-state
functioning, with the corresponding ﬁgure in the face-to-face
group being 27.5% (11/40). High end-state was deﬁned as being free
of panic and having a panic disorder clinician severity rating of less
than 2 (on a 0–8 scale).
Our Swedish group has independently conducted similar
research with three controlled trials all showing positive outcomes
(Carlbring, Westling, Ljungstrand, Ekselius, & Andersson, 2001,
Carlbring, Ekselius, & Andersson 2003; Carlbring et al., 2006 ), and
a direct comparison between face-to-face and Internet-delivered
CBT (Carlbring et al., 2005). In the Carlbring et al. (2003) study two
active online treatments were compared (CBT versus applied
relaxation), showing small differences in outcome. While this could
be viewed as an argument for placebo effects in online CBT, we
hesitated to draw that conclusion as applied relaxation following
the protocol of O
st (1987) has been found to generate good
outcome in Swedish panic trials (e.g., O
st & Westling, 1995). In
terms of effect sizes we have generally found high standardised
effect sizes, both for primary panic-related outcomes and
secondary outcomes. For example, in the trial in which we added
brief weekly supportive telephone calls ( Carlbring et al., 2006), the
mean between group effect size across all measures was d ¼ 1.00,
and outcomes were sustained at 9-month follow-up.
A third research group has independently tested Internet-
delivered CBT for panic disorder, again showing that the treatment
concept appears to hold (Schneider
Marks, & Bach-
ofen, 2005). The trial by that group differs in many respects from
the trials conducted by the Australian and Swedish research groups,
as in the outcome measures used. Overall, however the three
independent replications by different research groups all point in
a similar direction. A problem is that most trials have been small
and there are few effectiveness studies showing that the treatment
works in regular health care settings. A recent exception was an
open uncontrolled Swedish trial in which we found that the results
from the efﬁcacy trials were replicated in a psychiatric setting
m et al., 2009).
With all these trials we still need to be cautious as policy makers
and some clinicians immediately infer that Internet delivery is close
to free once the costs for programming have been covered. This is
not the case. For example, the role of support was indirectly showed
by Farvolden et al. (2005) who had a poor outcome and a huge
dropout rate when no guidance was provided and the Internet
program was made freely available.
Social anxiety disorder
Our research group inevitably came across social anxiety
disorder (SAD)/social phobia in our research on panic as we had to
exclude people who did not fulﬁl the criteria for panic disorder and
mainly had their panic attacks in social situations. At the outset we
ﬁrst believed that it could not be enough to use a mainly text-based
treatment (albeit with instructions on how self-exposure should be
conducted), and hence we added two live group exposure sessions
in our ﬁrst study (Andersson, Carlbring et al., 2006). In the
following trial we omitted the live exposures (Carlbring et al.,
2007), which did not affect the outcome. Further trials from our
group corroborate these preliminary ﬁndings (e.g., Tillfors et al.,
2008), and between group effect sizes against no treatment
controls ranging between d ¼ .73 to d ¼ .98 for the Liebowitz Social
Anxiety Scale self-report version (Baker, Heinrichs, Kim, & Hof-
mann, 2002) have been reported. Two other research groups have
found similar effects. Titov and coworkers in Australia reported two
trials (Titov, Andrews, Schwencke, Drobny, & Einstein, 2008; Titov,
Andrews, & Schwencke, 2008), with between group effect sizes
above d ¼ .80. Berger, Hohl, and Caspar (2008) in Switzerland have
replicated the ﬁndings as well, with the common elements being
a structured CBT program and guidance via Internet.
It is not obvious that Internet-delivered CBT should work for
patients with SAD. It could be argued that we instead reinforce
their avoidance of contact with people. Indeed it has been found
that persons with severe social anxiety disorder do use the Internet
extensively (Erwina, Turk, Heimberg, Frescoa, & Hantula, 2004). On
the other hand, the ’’safe’’ environment in front of the computer
might facilitate the necessary learning phase in CBT, in which the
principles of treatment are described (e.g., rationale). Exposure and
modiﬁcation of behaviours such as safety behaviours in real life will
however be needed, and are parts of the effective programs. Our
experience so far is that many persons with social anxiety manage
to go out and seek exposure with the guidance of a self-help
programme and an online support person.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is a debilitating condi-
tion with marked symptoms of avoidance and intrusions that can
have a signiﬁcant negative impact on the quality of life (Keane &
Barlow, 2002). As with other anxiety disorders shame is often
involved and hence, the prospect of receiving treatment from
G. Andersson / Behaviour Research and Therapy 47 (2009) 175–180176
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a distance can appear appealing. At least four different research
groups have developed Internet treatments for symptoms of
PTSD. First were a Dutch group who developed their own
approach called ‘‘Interapy’’ (Lange, van de Ven, & Schrieken,
20 03). This protocol has been tested in RCTs (e.g., Lange, Rietdijk
et al., 2003), and includes many ingredients involving structured
writing assignments in line with the work by Pennebaker (1993).
Another research group conducted a small controlled study on an
Internet-based self-help program with some therapist support
(Hirai & Clum, 2005). Improvements were observed with above
half of the treated participants showing clinically signiﬁcant
improvement. A third research group has completed a series of
studies on trauma and grief, focusing on the working alliance, and
found high patient ratings of therapeutic alliance in Internet
treatment, as well as improvements on symptoms measures
(e.g., Knaevelsrud & Maercker, 2007). This group used the same
program as the Lange group (Lange, Rietdijk et al., 2003), and
replicated their ﬁndings. Independently, a fourth group have
developed and tested an Internet-based CBT treatment for PTSD
(Litz, Engel, Bryant, & Papa, 2007). In their controlled trial they
had an active control group, which is uncommon in this research
ﬁeld. The authors reported a between group effect size of d ¼ 0.95
for their overall measure of PTSD symptoms, when considering
treatment completers at 6-month follow-up. Using intent-to-treat
analyses they reported that a signiﬁcantly greater percentage of
cases in the CBT group no longer met criteria for PTSD at the 6-
month follow-up. With most studies on PTSD pointing in the
same direction, and with independent research groups replicating
the ﬁndings, it is important to further test and develop Internet-
based treatment of PTSD.
Depression represents one of the major challenges for mainte-
nance of public health (Ebmeier, Donaghey, & Steele, 2006). At least
in a mild to moderate form, depression tends to respond well to
most forms of psychotherapy (Cuijpers, van Straten, Andersson, &
van Oppen, 2008b). This includes self-help interventions (Cuijpers,
1997), and several trials on Internet-delivered CBT have been
conducted by different research groups (Andersson, 2006). Our
own experience in using a guided Internet-delivered program in
three controlled trials has been positive. In the published trial we
found a high between group effect size (d ¼ 0.90) for the main
outcome measure (Andersson, Bergstro
m et al., 2005). Equally
promising outcomes have been reported in the Netherlands (Spek,
Nyklicek, et al. 2007). Other groups have found somewhat lower
effects (Christensen, Grifﬁths, & Jorm,20 04), and even lower effects
and large dropout rates when no support is provided (Christensen,
Grifﬁths, Mackinnon, & Brittliffe, 2006), but the public health
perspective can still make these low cost alternatives suitable as
early interventions in a stepped-care process. Another group has
also conﬁrmed that Internet-delivered treatment can work but that
some kind of guidance might be needed when targeting depressive
symptoms (Clarke et al., 2002, 2005). It remains to be seen if
depression is particularly sensitive to the need for a therapist, with
at least a few unguided programs showing very weak or non-
existent beneﬁts (e.g., Patten, 2003). It is important to know that
most studies in the ﬁeld of mood disorders and Internet treatment
have not dealt with diagnosed cases of major depression (e.g.,
O’Kearney, Gibson, Christensen, & Grifﬁths, 2006), but rather
people with depressive symptoms (Andersson & Cuijpers, 2008).
The literature on Internet-based treatment of major depression and
symptoms is scattered with several research groups
being active. For example, some researchers focus more on
prevention and early intervention (Van Voorhees et al., 2007).
Overall, the evidence is promising and future studies could target
well diagnosed patients as well as maintenance of treatment gains.
Other health problems
There are several other conditions for which guided Internet-
delivered CBT has been tested (Cuijpers et al., 2008a). In our
research group we have conducted controlled trials on tinnitus
(Kaldo et al., 2008), headache (Andersson, Lundstro
m, & Stro
20 03), insomnia (Stro
m, Pettersson, & Andersson, 2004), and
chronic pain (Buhrman, Fa
m, & Andersson, 2004).
Other targets of Internet-based intervention have included patho-
logical gambling (Carlbring & Smit, 2008), eating disorders (Ljo
son et al., 2007), obesity (Tate, Wing, & Winett, 2001), and stress
management (Zetterqvist, Maanmies, Stro
m, & Andersson, 2003).
Given the number of completed and ongoing trials from different
research groups around the world it is safe to conclude that
Internet-delivered CBT is here to stay. What is less clear is the
format of therapy. For example, the Internet can be used as an
adjunct to existing treatments (Spence, Holmes, March, & Lipp,
20 06), and online assessment procedures are increasingly used in
research and clinic (Andersson, Ritterband, & Carlbring, 2008). It is
now fairly established that psychometric properties of self-report
measures tend to transfer well when the same questionnaires are
administered via the Internet, but that each instrument needs to be
validated for online use (Buchanan, 2003). A likely development in
the near future is that we will see more use of the Internet in
regular clinical practice.
The Internet and the therapist
Emerging evidence across trials clearly suggests that the
computer cannot totally replace human contact, even if it can be
minimised. In fact, we found a correlation of rho ¼ 0.75 (p < 0.005)
between the amount of therapist contact in minutes and the
between group effect size in 15 trials dealing with psychiatric
conditions (Palmqvist, Carlbring, & Andersson, 2007). It is possible
that there is a cut-off point below which smaller effects and more
dropouts are seen. Indeed, this is especially clear in online
depression treatments as little or no therapist contact either via live
meetings, telephone calls or e-mails tend to increase dropout and
reduce effects markedly (Christensen et al., 2006). Spek, Cujpers
et al. (2007) found similar effects of human support in their meta-
A common question is whether Internet treatment can generate
a positive working alliance (Cook & Doyle, 2002). Overall, Internet-
based treatments tend to generate a strong therapeutic alliance
Knaevelsrud & Maercker, 2007),
being strongly associ-
ated with outcome. Some indications of a weaker alliance in
Internet treatments as compared with live CBT have been noted,
albeit not statistically signiﬁcant (Klein et al., 2006).
Yet another way to investigate if the therapist is important is to
analyse the variance in treatment outcome attributed to the ther-
apist. Using data from three controlled trials on panic disorder,
social phobia and generalised anxiety disorder (total N ¼ 119), with
respect to the individual therapists (N ¼ 8) who gave support
during the treatment period, we have found very small therapist
v et al., 2008). This does not rule out the importance
of expertise. First, in many of our Swedish trials we have had
students under supervision as therapists, and it is possible that they
improvise less or adhere more to the protocol as they have little
clinical experience to rely on. Second, the self-help texts used in the
treatments can also reﬂect clinical experience and empathy, and as
the text material is the same for all trial participants it is rather the
interaction with the therapist and the text that is relevant to
G. Andersson / Behaviour Research and Therapy 47 (2009) 175–180 177
Author's personal copy
consider. For example, if a therapist does not fully understand the
text material, perhaps not having a robust knowledge of CBT, it is
likely that difference in between skilled versus less skilled thera-
pists will be more noticeable.
In sum, there are clear indications that the presence of an online
therapist guiding the patients and providing feedback is important
for adherence and outcome. A therapeutic alliance can also develop
in online treatments, but thus far we cannot say that it matters
much who the therapist is.
For whom is Internet-based treatment suitable?
Some obvious limitations relate to comprehension of text
materials and computer expertise. In many studies, patients who
lack these characteristics are excluded. It does not have to be this
way however, as multimedia presentations (e.g., video and audio
ﬁles online), and simpliﬁed language can be used to handle these
obstacles. Another limitation relates to comorbidity and the mere
fact that an evidence-based treatment, with its research base
coming from standard individual therapy, does not necessarily
lends itself to the self-help format. On the other hand comorbidity
is not always an obstacle in CBT (e.g., Ramnero
st, 2004), and in
the few studies available on Internet-delivered CBT few consistent
predictors have been identiﬁed. In a depression trial we found
a negative correlation between change scores on the main
depression outcome measure and number of previous depression
episodes (Andersson, Bergstro
ndare, Ekselius, & Carlbring,
It is also possible that differential predictors of live versus face-
to-face treatment outcomes exist. For example, agoraphobic
avoidance was predictive of outcome in the face-to-face treatment,
but not in the Internet treatment (Andersson, Carlbring, & Grim-
lund, 2008). A self-report screening of personality disorder
(anxious cluster) was associated with the worse outcome for the
Internet treatment, but surprisingly associated with better outcome
in face-to-face treatment. Cognitive capacity as measured by a test
of verbal ﬂuency was not predictive of outcome in the Internet
group, and neither was a rating of treatment credibility. Spek,
Nyklicek, Cuijpers, and Pop (2008) investigated predictors of
outcome of group versus Internet-based CBT for depression. They
found that higher baseline depression scores, female gender, and
low neuroticism predicted better outcome for both groups, but
altruism (as a personality factor) was only related to outcome in the
live group treatment. It is yet premature to draw any conclusions
regarding different predictors, and even less so regarding the
neglected issue of moderators and mediators of outcome in
Internet-delivered CBT. Mediators might include understanding the
written material in the programs, adherence to the homework
conducted, but could also involve other aspects relating more
directly to online behaviours (such as how the website is accessed).
Treatment credibility is another topic that has been investigated
in some trials. For example in one panic trial we compared credi-
bility ratings between live versus Internet CBT (Carlbring et al.,
20 05). Credibility ratings were signiﬁcantly higher in the face-to-
face treatment condition versus the Internet conditions. A similar
observation was made in a tinnitus trial comparing Internet versus
live group treatment (Kaldo et al., 2008). In terms of prediction we
have found treatment credibility to be predictive of outcome of
Internet-delivered CBT in some studies (e.g., Carlbring et al., 2006),
but not in others (e.g., Carlbring et al., 2001).
Therapists’ attitudes towards Internet treatment are important.
Wangberg, Gammon, and Spitznogle (2007) did a survey on
psychologists in Norway and found that most were rather neutral
regarding the use of the Internet, and a few were very negative.
Moreover, they found that a CBT orientation was associated with
a more positive attitude towards using the Internet than having
a psychodynamic orientation. A similar result was obtained by
Mora, Nevid, and Chaplin (2008), with CBT practitioners being
more positive than psychoanalytically oriented practitioners.
In sum, we have limited knowledge on predictors of outcome
making it hard to state for whom Internet treatment is unsuitable.
Treatment credibility tends to slightly lower than for face-to-face
treatments, and many practitioners of therapy still hesitate to
endorse Internet-based treatments. CBT clinicians however tend to
be more positive.
It is not difﬁcult to identify future challenges regarding Internet-
delivered CBT. Methodological problems are one. High attrition in
some studies is one example. Lack of proper diagnoses in many
. It is also difﬁcult to grasp the content of the self-
help materials used, and the content of treatment programs and
compliance with the treatment could be described better. Another
issue has to do with costs of developing and implementing the
interventions, for example describing the amount of time spent
with each client during the treatment.
A second challenge has to do with dissemination and effec-
tiveness research. While CBT now increasingly has been found to
work in regular clinical settings (Hunsley & Lee, 2007), there are
only a few Internet studies in which the treatment has been
implemented in clinical settings. Some are not really full CBT
treatment programs but should rather be seen ‘‘information’’,
potentially acting as an early step in a stepped-care process. These
programs might very well be feasible from a public health point of
view (Andersson & Cuijpers, 2008). Program such as the ‘‘blue
pages’’ necessitates little if any clinician input (Christensen et al.,
2004), and a large group of people can be given access to the
information content. While clinician input is minimised in the
effective programs, it is still there. From the patient perspective it is
just as time consuming and demanding as live CBT. The main
advantage lies in overcoming distances as clients can get treatment
even if they live far away provided that they have Internet access.
Different treatment formats can be combined. We have tested
combined treatments (e.g., live exposure and Internet treatment) in
some studies. It is possible that future clinicians will stay in touch
with their clients via the Internet (or in some other manner such as
mobile phones) while still having treatment sessions in the clinic. A
potential use of the Internet could be as a tool in relapse prevention,
following an intervention in the clinic. Online maintenance
programs and check-ups could then be used. In fact, most likely the
Internet will be used in some way in more or less all future treat-
ments. Homework assignments could be handled via secure web-
pages. This would be feasible in intensive treatments (for example
with obsessive-compulsive disorder when daily exposure and
response prevention is called for). New technology should not be
automatically seen as a replacement, but rather as a complement to
existing treatment protocols.
Finally, a fourth challenge is to take advantage of the treatment
format. We have recently begun to test tailored treatments using
modiﬁed versions of treatment modules from different programs.
For example, a person with anxiety might fulﬁl the criteria for one
anxiety diagnosis and partly for other diagnoses. In fact, comor-
bidity across the anxiety and mood disorders is more common than
not (Barlow, 2002). This person could be given a tailored program.
This kind of tailored program could consist of psychoeducation,
cognitive restructuring, exposure to both interoceptive (from the
panic program) and social (from the social phobia program) stimuli.
In conclusion, we are only seeing the beginning of Internet-
delivered CBT. It might even be a paradigm shift as CBT clinicians
G. Andersson / Behaviour Research and Therapy 47 (2009) 175–180178
Author's personal copy
are increasingly using text materials in their treatments (Keeley,
Williams, & Shapiro, 2002), and the Internet can be used not only to
present text but also ﬁlms, and audio ﬁles, structured self-assess-
ments, discussion groups, and many other functions. We are now in
a position that we can safely conclude that Internet-delivered CBT
tends to work for a range of problems for at least some of our
patients. Given the lack of trained CBT practitioners and low uptake
of evidence-based treatments (Lovell & Richards, 2000), it would be
inappropriate not to use Internet treatment at least as a comple-
ment to our other treatments.
Co-workers in my research group and former students are
thanked as well as international colleagues in the International
Society for Research on Internet Interventions (http://www.isrii.
org). Finally, my research has been supported by the Swedish
Council for Working and Life Research, Swedish Cancer Foundation,
and the Swedish Research Council.
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